Gave a patient someone else's unwasted dilaudid

[Daliadreamer]

First of all, let me tell you a little background about myself. I graduated in 08 and found a job at a rehab facility because no one would hire a new grad at a hospital unless you knew someone. I worked there for a year, and I think I shot myself in the foot because I lost most of my skills. I just got a new job at a hospital in March, and this week was my first week off orientation.

While I was on orientation, I loved it! All the nurses were helpful, especially because I was kind of still considered a new grad. It was a great experience. This week was my first week off orientation and it was AWFUL. I almost want to consider a career change. All of a sudden no one really wants to help me and it is super super busy and I am so overwhelmed. I have anxiety every day before I go to work. I work the pm shift so I have all morning to think about going to work. I cry at the end of the shift. I keep making silly mistakes; little ones, but still.

Anyway, here is my dilemma.

I had a patient yesterday who requested dilaudid. Her dose is 1mg out of a 2mg carpujet syringe. I gave her the 1mg and put the carpujet in my lab coat pocket. She didn't ask for a dose later in the night, and I ended up taking the dilaudid home because it was in my pocket. Today, I had another patient on dilaudid, and he had a dose of 1mg, out of a 1mg syringe, but the pyxis was out of stock. I realized that I had the other dilaudid in my pocket and used that instead of waiting to ask the pharmacy to fill the pyxis. I had to give up this particular patient soon thereafter because I also had a MRSA patient and the charge nurse wanted my other patient to be 'clean' based on his history. I have report to the charge nurse. He apparently wanted more dilaudid later, and the charge nurse looked up on the pyxis when I last gave it to him. Of course it wasn't in there. At this point, I had gotten a direct admit, I was way behind on all my patients, very overwhelmed and on the verge of crying. The nurse asked me if I had used leftover dilaudid from the other nurse (who had given me report). In my state of anxiety, I quickly said 'yes' (stupid, I know). It wasn't until after the charge nurse had left at 7p that I realized what I had said. I cried on my way home, scared and upset. I am definately going to tell her what happened tomorrow. I don't know if I am going to have a write up or not, but at this point I am unfortunately too numb, overwelmed, tired, hungry, anxious and tired to care. I hate what this place has made me feel. But it feels good to talk about it.

[Hoozdo, ADN]

Please find another nurse to waste with you next time you pull out a narcotic

from the Pyxis. I know it is difficult when it's busy, but necessary to protect

your license.

You are new to the unit, have narcotics missing, and that is suspicious. Be

sure to tell the charge nurse that in the heat of the moment, you did not

understand the question and misstated what happened. If they go back in

the Pyxis history, they will see what happened and it will appear as if you

lied.

In the future, before the end of your shift, make it a habit to tidy your rooms and

look for any drugs you might have inadvertently left out in the open. Not just

narcotics, but any drugs.

Please let us know what happens. Best of luck.

[elkpark]

In the future, before the end of your shift, make it a habit to tidy your rooms and look for any drugs you might have inadvertently left out in the open. Not just

narcotics, but any drugs.

And "pat down" your pockets ... This is why one of the classic, "old fogey" rules of nursing is to never put any medications in your pockets. It's too easy to inadvertently walk away with them.

Hope this will turn out ok for you. Best wishes.

[iluvivt, BSN, RN]

Unfortunately, NOBODY wants to hear" I was too busy to do it the right way "and it is very difficult to explain just how crazy busy you were after the fact. YES it is very difficult at first..it will probably take at least one full year before you begin to feel a bit more comfortable so just expect that and remember every day will get better. Medication errors and medication safety is a HUGE issue and you have to learn to follow some cardinal rules. In this case always dispose of your waste/discard per hospital policy.... especially narcotics..and never use leftover medication signed out for a patient on another patient. How does management know that you did not take the leftover Dilaudid and put something else in its place..plus you did not leave a computer footprint for the dosage you gave to the second patient.....it happens all the time..and you NEVER want to jeopardize your ABILITY to earn an income or your ability to provide SAFE patient care. Continue to interact with your co-workers and offer to help out when you can..establish good working relationships with them and they will continue to guide and help you during this period. Make a point of continuing to educate yourself...if you DO NOT know something...look it up...see if they have a time management course and take it......and I can not stress this enough....TAKE THE TIME to read the NURSING POLICIES and PROCEDURES..if its a GOOD hospital...they will be GOOD too..and you as an employee need to follow them....I am pointing this out as they will have a policy on medication administration...find it and read it.

[Zookeeper3]

Deep breath. You have learned early in your career that short cuts can have serious consequences. Knowing that, give yourself permission to take the time you need, period. YOu will be overwhelmed for several months and don't expect to get out on time. Take the time you need for med passes and order review and if you have to stay after shift to chart a narrative or tidy rooms than do it that way, just don't short change the important things. This is not a lecture, just supportive suggestions and simply use this bad judgement call to learn and stress what you'll do different to the nurse manager when you talk about this. The ability to learn from bad calls is the difference in a nurse that you can or can't mentor into a great one;)

[Sparx28]

Hey, I graduated in '08 too, so I understand all the anxiety esp when it comes to talking with management. I would definitely clarify what happened. At this point, they would probably put a note in your file but since you don't have a history of diverting meds i doubt they would penalize you.

Yeah, it's a pain to have to wait on pharmacy, but from Tylenol to steroids to pain meds we should wait on them to restock bc it's easier to deal with the delay than the mess it can cause by cutting corners. It's also confusing to have to remember who you gave what and it's easier to do it right the first time.

I couldn't find 2 Darvocet pills before and i was panicking because it was the end of my shift so I did'nt have much time to look(and i also work nights). I went and told my manager who was so scary about it and she made me write a statement. She also told me to never carry around pain meds for long. You should pull them and give pretty much right away. Luckily, when i went back to work that night, I found the pills underneath the keyboard inthe patients room what a relief. But it's our mistakes that teach us better practice.

Another thing to remember is hwen you pull up 1 mg, waste the other immediately, preferably with another nurse VISUALLY witnessing you. And like another nurse suggested, go through ALL pockets before you go home.:)

[mauxtav8r]

It's a real nuisance, but the ONLY location for unwasted med is IN YOUR HAND.

Hang in there, dear. This is a painful experience for you but you can become a better nurse from it.

[Daliadreamer]

Thanks everyone- Well, I couldn't sleep at all, so at 7a I called the unit and explained to the charge nurse what happened, and she was actually very supportive. Her main concern was that the right dose of the med was given, and then, in the most gentle tone possible she said don't do it again and she's going to figure out what to do when I get there today.

[Meriwhen, ASN, BSN, MSN, RN]

Where I work, sometimes we'll use unwasted medications (such as half of a phenobarbital tablet) on another patient provided that two nurses witness it and it's carefully documented that the unused portion was used for another patient. But it'd only be done if there was another patient who needed the dose that shift; we wouldn't keep an unwasted dose around for longer than that.

And it's never left in the pocket or patient's med drawer--it's placed back in the narc locker until it's used/wasted.

I hope it all works out for you!

[shiccy]

I think every nurse has made the mistake of taking a narc home because they had put it in their pocket. I had a patient that was getting pain meds fairly frequently the first night I had him, and slept most of the next night. He was a patient that would go from snoring to total pain city.

I had heard what I thought was a pain moan from him. I grabbed a narc and gowned up (iso room). I was actually kind of expecting him to call out because he hadn't gotten ANYTHING since the prior shift, and this was 6:30am the next day.

When I walked in he was having periods of apnea and genuinely didn't look right. I was still in orientation, so I asked my preceptor to come in. While his sats were mid to high 90's on his O's, but w/ the resp depression and general lethargy we obv. weren't going to give him more narcs. I put it in my pocket so I could waste it when I got out of the room (remember, iso). We ended up using two rounds of narcan and he made a full recovery.

Since this all happened at shift change time, I left for home and then emptied my pockets out and said, "S**t." ... The morphine was still in my pocket. I was exhausted at this point, but since it was a narc I immediately called my floor manager. She had me come in and find her, wasted the narc in the Pixis and obv. in front of her (was still in the carpuject syringe, which I LOVE), and I believe we wrote up an incident report. Needless to say I've never done that EVER again.

EVERYBODY makes a mistake or even a few. Please remember, though, esp. with carpuject syringes, you CAN NOT use them on more than one patient. I'm pretty sure that's a standard for many or most hospitals for infectious disease reasons. It doesn't matter how long you scrub - you potentially are infecting one person with another persons germs. ... if you ask an admin, they'd tell you this is tantamount to using a syringe twice on two people - it's just never done.

[PostOpPrincess, BSN, RN]

NEVER do that again.

It's more than just the fact that you took it home (happens all the time) you gave someone else's meds to ANOTHER PERSON.

THAT is a big no no and in my eyes a good reason to have you terminated.

You should've wasted a 2 mg IV and have someone witnessed it.

What you did is wrong and I am telling you it is wrong.

[CrazierThanYou]

NEVER do that again.

It's more than just the fact that you took it home (happens all the time) you gave someone else's meds to ANOTHER PERSON.

THAT is a big no no and in my eyes a good reason to have you terminated.

You should've wasted a 2 mg IV and have someone witnessed it.

What you did is wrong and I am telling you it is wrong.

I have a question related to your comment. My situation is a little different: I am a CNA/nursing student working in an assisted living home. Our residents are regularly out of one kind of their medications or another (its the administrator/owner's job to keep them filled). If we have 2 residents on a certain medication and one of them is out, the administrator will just say "Oh, you can borrow from ________'s meds". I don't feel this is an acceptable practice. Instead, I think the administrator should be sure everyone has their meds when they need them. What do you think?